Thursday, April 04, 2013

The medical neglect of the African mouth

In some ways, dentistry is the black sheep of the medical family. The social status of dentist in most places does not seem to be on a par with that of a (real) medical doctor. It is not entirely clear why this is the case, but there are conjectures. Perhaps because a trip to the dentist is commonly associated with pain, despite advances in dental anesthetics. Maybe it has to do with historical associations: what later was called 'dentistry' emerged from the Medieval practices of barbers, who besides cutting hair were self-proclaimed experts in tooth extraction. Or it could be that oral conditions are just not to be taken seriously, in the sense that they are generally not life-threatening: this is what separates the dentist from the cardiologist or neurosurgeon. In any case, when dentistry is taken less seriously, it is seen as a lesser priority by funders and policy makers, not to mention the faint attention it is generally given by bioethicists.

A recent article reminded me of the sorry state of dental research, practice and policy in Africa. When health care systems are compromised by poverty and civil conflict, dentistry is regarded as a luxury and treated accordingly.  The article is focused on Swaziland: a country of 1.2 million persons served by nine private dentists, along with another 15 public dental practitioners, although the latter do not have the specialized skills to conduct root canal procedures or the fitting of dentures. What's worse is that the diet of Swaziland (like much of Africa) is becoming more 'Westernized', i.e. more processed and sugary foods are hitting the markets, leading to cavities unlikely to be filled. A rise of a neo-Medieval practice of tooth extraction is likely to accompany the change in food habits.

While oral conditions are not typically life-threatening, anyone with a toothache (or other dental conditions) can attest to their negative impact on quality of life. And quality of life, on that level, anything but a luxury. Given the track record on affordable and equitable access to primary health care on the continent, as well as the traditional subservient position of dentistry within the culture of medicine, the road to better dental health and dental practice in Africa looks to be long, hard and bumpy.


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